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    <h1>E-LEARNING REGISTRATION</h1>
    <p>Page 2 of 3</p>
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        <span style="font-size:10.0pt;font-family:&quot;Century Gothic&quot;;mso-ascii-font-family:
&quot;Century Gothic&quot;;mso-fareast-font-family:&quot;Century Gothic&quot;;mso-bidi-font-family:
&quot;Century Gothic&quot;;language:en-SG;font-weight:bold">Consent Form for E-learning Pilot Program on Depression</span></p>
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    <p style="language:en-SG;margin-top:0pt;margin-bottom:0pt;margin-left:0in">
        <span style="font-size:9.0pt;font-family:&quot;Century Gothic&quot;;mso-ascii-font-family:&quot;Century Gothic&quot;;
mso-fareast-font-family:&quot;Century Gothic&quot;;mso-bidi-font-family:&quot;Century Gothic&quot;;
language:en-SG">I am interested in the e-learning pilot program on depression. I understand that e-CBT is designed as a program to educate myself on my thought patterns and help improve my mood over 8-10 weeks of time.</span></p>
    <p style="language:en-SG;margin-top:0pt;margin-bottom:0pt;margin-left:0in">
        <span style="font-size:9.0pt;font-family:&quot;Century Gothic&quot;;mso-ascii-font-family:&quot;Century Gothic&quot;;
mso-fareast-font-family:&quot;Century Gothic&quot;;mso-bidi-font-family:&quot;Century Gothic&quot;;
language:en-SG">I understand that all my information will be kept strictly confidential and I consent to being contacted via email/SMS. I consent to the use of my anonymous data for the evaluation of the service.</span></p>
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    Please check accordingly:
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        <asp:ListItem Value="KTPHPatient">I am a patient of KTPH Psychological Medicine Department.</asp:ListItem>
        <asp:ListItem Value="Diagnosed">I have been formally diagnosed as having Major Depressive Disorder of mild to moderate severity.</asp:ListItem>
        <asp:ListItem Value="EighteenNAbove">I am 18 years old and above</asp:ListItem>
        <asp:ListItem Value="NotSucidal">I am currently not suicidal and I understand that this form of therapy is not a crisis intervention program.</asp:ListItem>
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